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Please provide complete information for assessment of your chances for
immigration to Canada

  • You must complete this form electronically
    • GENERAL INFORMATION

    I would like to have Assessment for immigration to Canana
    I am interested in Work permit of Canada

    Last First Middle
    Name: Male: Female:
    Address:
    Home Telephone: Work Telephone: Fax:
    Day Month Year
    Date of Birth: Email:
    City Province Country
    Place of Brth:
    Country of citizenship: Marital status:
    City Country
    If married, Where were you married?:
    Day Month Year Last First Middle
    Date of marriage: Spouse's name:
    Day Month Year
    Spouse's date of birth:
    Destination in Canada, Australia, New Zealand:
    Yes / No
    Have you ever been to your intended country of immigration?:
    If yes, when?:
    If yes, where?: If yes, How long did you stay?:
    Purpose of visit: Your Passport No.:
    Day Month Year
    Expiry date of Passport:
    Have you ever been convicted of a crime?:
    If yes, give date, place and explanation:

    Have you ever been a member of any association in favour of relations, either cultural or economical,
    between your country and intended immigration country?:

    Date From-To Name of Assoc. Address of Assoc. Type of Assoc. Position or Title.


    Have you ever been refused a visa or an application to immigrate to any country
    (if yes, state date and province of desination)?
    Date Province / state of destination.


    LANGUAGE SKILLS

    Written Spoken Read
    Knowledge of english:
    Written Spoken Read
    Knowledge of french:
    Mother tougue:
    Have you ever taken TOEFL or IELTS test? If yes, provide date and score:

    CHILDREN

    Last Name 1st Name 2nd Name Birth Date (D/M/Y) Birth Place (City/Country) Level of education




    Will your children accompany you ?: yes: no:

    RESIDENCE (for the past 10 years)



    EDUCATION (PLEASE WRITE ALL YOUR EDUCATION)

    Number of years attended:
    Primary: High School: Vocational: University:
    Other (specify):
    Have you ever taken education in French Language

    HIGH SCHOOL ATTENDED

    COLLEGE OR VOCATIONAL SCHOOL

    UNIVERSITY ATTENDED



    EMPLOYMENT (for the past 10 years)





    IN THE FOLLOWING SECTION COMPLETE SPOUSE INFORMATION, IF YOU ARE MARRIED
    SPOUSE LANGUAGE SKILLS

    Written Spoken Read
    Knowledge of english:
    Written Spoken Read
    Knowledge of french:
    Mother tougue:
    Have you ever taken TOEFL or IELTS test? If yes, provide date and score:

    SPOUSE RESIDENCE (for the past 10 years)



    SPOUSE EDUCATION (PLEASE WRITE ALL YOUR EDUCATION)

    Number of years attended:
    Primary: High School: Vocational: University:
    Other (specify):
    Have you ever taken education in French Language

    HIGH SCHOOL ATTENDED

    COLLEGE OR VOCATIONAL SCHOOL

    UNIVERSITY ATTENDED




    SPOUSE EMPLOYMENT (for the past 10 years)





    RELATIVES OR FRIENDS IN THE COUNTRY WHERE YOU WISH TO IMMIGRATE?
    Are your parents, children, brothers, sisters, aunts, uncles, neices, nephews, grandparents, or grandchildren citizens and/or permanent residents?

    Do any of these relatives have a business ? If yes describe type of business:


    PERSON WHO SHALL ASSIST YOU IF ANY:
    The following person, employer or organization has offered to assist me after arrival(name, address and copy of job offer, if you have one):
    Name:
    Address:
    Telephone:
    Relationship:
    Kind of assitance offered:


    NET WORTH
    How much money will you have in your possession upon your arrival in ?:

    I have the following assets: (show amount of value):
    Transferable money Property Monthly transferable pension
    Other


    I have the following debts or legal obligations (e.g. child support payments) owing to (give name of person(s) or organization):
    Name: Total Debts:
    How did you hear about our firm?:

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